Maintaining a Sterile Field

Maintaining a Sterile Field

Some body mod practitioners attempt to draw a line between the concept of sterility, meaning the contents of a sterilized container or package and the application of asepsis, which is the procedural method of infection prevention.

“aseptic technique:
any health care procedure in which added precautions, such as use of sterile gloves and instruments, are used to prevent contamination of a person, object, or area by microorganisms.”
Definition — Mosby’s Medical Dictionary, 8th edition. © 2009, Elsevier.

“aseptic [a-sep´tik]:
free from infection; called also sterile.
aseptic fever fever associated with aseptic wounds, presumably due to the disintegration of leukocytes or to the absorption of avascular or traumatized tissue.
aseptic technique the use of surgical practices that restrict microorganisms in the environment and prevent contamination of the surgical wound (see surgical asepsis). Called also sterile technique.”
Definition — Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

Request for comment

      1. Can you elaborate on your antisepsis and practices for maintaining asepsis?
      2. Would you share with me what you consider excessive, or frivolous safety practices?
Sterile tray and drape options
Sterile tray and drape options

I encourage my colleagues all use appropriate sterile barriers and no-touch procedures for safety. I am sincerely curious why people use dental bibs instead of sterile drapes for setup tray covers for body art procedures.

A sterile drape serves to provide a sterile field onto which the contents of sterilized packages or containers may be setup. Even better, an impermeable product such as a waterproof sterile tray or surgical drape served to prevent strike through and cross contamination. Custom kits can be assembled and sterilized together to reduce waste.

Surgical Drapes are designed to establish and maintain a sterile field. It is very important to select a surgical drape that provides reliable performance. To achieve the best surgical outcomes, look for surgical drapes with these qualities:

3M™ Steri-Drape™ 9000 Surgical Drapes

Steri-Drape 9000 material consists of a laminate of polypropylene fibres and a polyethylene film. These materials are by-products of the oil industry. There is no cellulose in these drapes, which means that no trees are used in their manufacture. The products do not present a significant risk to the environment when incinerated after use and are broken down to carbon dioxide and water.

Impervious to Strikethrough

A drape that allows fluid transfer, and thus bacteria transfer, compromises the sterile field, which increases the risk of wound infection. That is why a drape that is impervious to liquid strikethrough is so important. 3M™ Surgical Drapes, Gowns and Custom Procedure Trays Range Guide

For more information, download:
3M™ Surgical Drapes, Gowns and Custom Procedure Trays Range Guide

A dental bib provides only a temporary moisture barrier with some absorbency to protect clothing.

A dental bib appears to clients as misleading “look-alike” product, and is an ineffective substitute for a sterile drape. When a bib is used instead of a sterile field, items that should be maintained sterile, such as jewelry, needle, lube and other touch and transfer surfaces can be compromised by contact with the bib. They seem to offer a false sense of security. 

I have also observed they are sometimes used to cover setup trays out of habit, without serving any purpose other than to color the tray.

Reduce the waste: A dental bib is not necessary.

A sterile drape should be waterproof and impervious to strikethrough. A drape that allows fluid transfer, and thus bacteria transfer, compromises the sterile field, which increases the risk of wound infection. That is why a drape that is impervious to liquid strikethrough is so important.
A sterile drape should be waterproof and impervious to strikethrough.
  • Dental bibs are not tested and validated to prevent cross contamination or strike through like many sterile drapes.
  • If items that must touch the client are set up on the surface, then a sterile drape or sterile tray would be appropriate instead of a non-sterile dental bib.
  •  If the bib only serves as a surface for sterile packages to sit on, and instruments, jewelry, lubricant and other sterile items never touch the surface of the bib, then it should only be considered as a dust cover for the tray.
  • A dental bib does not serve as Personal Protective Equipment for cleanup after a procedure and may not be used as a barrier in place of gloves.
Sterile kit options
Some sterile tray and drape kit options can include a mask, non-latex gloves, swabs, gauze, tweezers, clamps, scissors, gallipots, kidney trays, etc.

In my observation dental bibs serve only as added waste, and can be avoided for body art procedures.

Options:

  • Many colleagues already use the inside wrapper of the sterile gloves as the sterile field. In places where the use of sterile gloves is already mandated such as France, Rhode Island, South Carolina and Florida, you probably do this all day. The inside wrapper of sterile packages will suffice for a sterile field, and the inside plastic of the outer glove wrapper can be used as a small area with a moisture barrier that should be impervious to strike through.
  • If you want to setup with sterile drapes, 3M, Kimberly Clarke, Dynarex, MedLine, Henry Schein, Viscot and others sell quality versions.
  • If you use a Statim autoclave, work out of the cassette or a rigid sterilization container for your sterile field. Line the bottom of the container with a single layer of gauze or CSR wrap if you feel it is needed to prevent small items from rolling.
  • Can CSR wrap act as a barrier to moisture? Yes.
CSR wrap is designed for package wrapping to avoid wet packs, and to provide a minimal moisture barrier when used as a sterile field.
CSR wrap is designed for package wrapping to avoid wet packs, and to provide a moisture barrier when used as a sterile field.

Henry Schein brand Autoclave Wrap (CSR) claims:

  • Economical Wrap
  • Superior barrier properties
  • High wet or dry tensile strength
  • Preserves sterile field, maintaining blood, saline, and alcohol repellency

 

 Other manufacturers

Video support for maintaining a sterile field

Presentation notes from Asepsis expert Sue Crow:

More discussion on this subject here:

Here is an 2003 video showing one option to drape a navel that has been cleaned and the antiseptic has dried. In this example, I used one 4 ply nonwoven gauze compress:
a triangle was cut on the center fold [ <]
opened to expose only the areas required to touch inside the diamond [ <> ]
*I’d suggest asking the client to fold under their jeans or lower them slightly to make more room to work.

10 thoughts on “Maintaining a Sterile Field”

  1. On my mind , the very important thing is also how to open packaging.
    Most of you use Statim and don’t have to open packaging.
    I don’t agree the 3rd vid, he makes the gauze jump onto the field, I wonder what would happen with the jewel ?
    My method is to open the packaging away from the field and drop it into the field on the sterile gauze which prevents the ball to roll outside the sterile field.

    • Very salient points, and a good suggestion for the practice of opening packages for small items such as jewelry.
      Many but not most of my colleagues use rigid sterilization containers or a Statim sterilization cassette.
      I strongly agree with the need for careful package opening and your suggestion. This is of utmost importance for both the spread of MRSA and other pathogens through shedding, and the loss of the package content. Packaging small items in a way that they are restrained by gauze or double wrapping them so that the inner package may be presented to the sterile field then opened with sterile gloves are rational solutions.

  2. in fact you mean : putting the jewel in a gauze and put the gauze in the packaging to prevent the fall outside the field? why not…gonna try next time I make a ste cycle.
    I’m not sure about the double wrapping concept: Ithink the steam would create condensation between the two wrap and that’s not good…I will try this and make a report about that. For sur it would allow us to open with steril gloves…I have to check that point…

  3. Yes, I do mean to put the fully disassembled jewelry inside a folded piece of gauze to keep each part from scratching the others, and to keep it together when presented to the sterile field. It works well. Double wrap is not a problem in any autoclave with active air removal. Your B program will work for double wrapped rigid containers, pouches or envelopes.

  4. Hi Brian,

    I was just wondering if you could clarify your use of the term sterile when used in the procedure set up? I agree that items should stay on a medically aseptic field. Is this what you are implying when you are stating sterile?

    The reason that I bring this up is that all the research I have done, as well as a Health Educators BBP course, all state that once a sterile package is opened to the air, it is no longer sterile. At best, all of our tools, jewelery, supplies are in a clean medical asepsis state. I am of the belief that we must use terms properly to minimize confusion within the industry as well as with the general public.

    I do find your articles to be extremely interesting and insightful.

    Thanks,
    Jay

    • Thanks for drawing the distinction, and I have added definitions to distinguish appropriate terminology.

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